Dementia poses many difficult challenges and choices to those living with the condition, and to those who are close to the person who has the disease. No one is spared the collective experience that dementia often causes when individuals and their families and friends and those in the role of professional caregivers are faced with as a result of the many cognitive and behavioural challenges that are often poignant and terrifying. During a recent media interview on the subject of behavioural symptoms associated with dementia and the array of potential interventions including medication therapy, I described to the media interviewer the special challenge that I have encountered when trying to address the complex and often terrifying events that affected holocaust survivors as their distant horrific experiences come to the forefront of their consciousness. This is usually much to the dismay of those caring or living with them who often seek some respite from health care professionals to help their loved one find relief from the horrors of their memories.
The interviewer, presumably as a way of categorizing the anecdote I was describing to her of a recent patient I saw in the clinic said, “Oh, I guess it is a post-traumatic stress disorder experience” which I agreed to without really having the chance to dissect and realize that the analogy was at best superficial. I realized that the comment an analogy did not fully capture the profound impact that the holocaust experience had for many of the older patients I care for and the effect that those life events of the holocaust itself added to what was for many a previous life as an outsider in a world in which they were never really welcome and for which the holocaust was a final devastating chapter on top of a life of fear and insecurity. I concluded to myself after the discussion that there was a different element to surviving the holocaust, especially in those from Eastern Europe that multiplied the concept of post-traumatic stress disorder as a way of understanding their experience of the holocaust and how it effects their life as they develop symptoms with dementia with its cognitive disruption and ultimately behavioural manifestations.
Most people who suffer the various iterations of post-traumatic stress disorder (PTSD) had prior to the event that was traumatic a reasonably “normal” life experience. That does not mean that everyone had a quiet, safe and sedate life but most did not have an experience of a comparable magnitude that was deemed to be the type of stress that can be categorized and sufficient to cause PTSD. Among the common events to which this syndrome has been ascribed is war and how it impacts soldiers who have survived,, people who have lived through natural disasters that resulted especially with the loss of life, either of close family and friends or of entire neighbourhoods or communities. For some it may have been a violent and close encounter as may occur in a capital crime such as a witnessed murder or the tragic loss of a loved one in other tragic events such as a motor vehicle accident. Whatever the cause, usually the preceding life experience was nowhere near the magnitude of the tragic occurrence as the event itself.
The difference that I have seen with many of the holocaust survivors that I have treated for dementia and related conditions is that prior to the holocaust they had witnessed or been subjected to a vast array of life-threatening, life-demeaning or harrowing experiences related to virulent anti-Semitism that was